Complementary Therapies in Medicine - Articles in Press

Comparative study on the effectiveness of myofascial release manual therapy and physical therapy for venous insufficiency in postmenopausal women - Corrected Proof

2012-05-04

Summary: Objectives: Venous insufficiency is present in a large number of postmenopausal women, increasing their risk of disability. The objective of this study was to determine the effects of myofascial release therapy and conventional kinesiotherapy on venous blood circulation, pain and quality of life in postmenopausal patients with venous insufficiency.Methods: A randomised controlled trial was undertaken. We enrolled 65 postmenopausal women with stage I or II venous insufficiency on the clinical, aetiological, anatomical and physiopathological (CEAP) scale of venous disorders, randomly assigning them to a control (n=32) or experimental (n=33) group. The control and experimental group patients underwent physical venous return therapy (kinesiotherapy) for a 10-week period, during which the experimental group patients also received 20 sessions of myofascial release therapy. Main outcome measures determined pre- and post-intervention were blood pressure, cell mass, intracellular water, basal metabolism, venous velocity, skin temperature, pain and quality of life.Results: Basal metabolism (P<0.047), intracellular water (P<0.041), diastolic blood pressure (P<0.046), venous blood flow velocity (P<0.048), pain (P<0.039) and emotional role (P<0.047) were significantly higher in the experimental group than in the control group after the 10-week treatment programme.Conclusion: The combination of myofascial release therapy and kinesiotherapy improves the venous return blood flow, pain and quality of life in postmenopausal women with venous insufficiency.

Prognosis following the use of complementary and alternative medicine in women diagnosed with breast cancer - Corrected Proof

2012-04-30

Summary: Objective: The purpose of this study was to assess whether CAM use affected breast cancer prognosis in those who did not receive systemic therapy.Design: Secondary data analysis of baseline/survey data from the Women's Healthy Eating and Living (WHEL) study. 2562 breast cancer survivors participating in the study completed baseline assessments and a CAM use questionnaire. Cox regression models were conducted to evaluate the use of CAM modalities and dietary supplements on time to an additional breast cancer event (mean follow-up=7.3 years).Setting: A US-based multi-site randomized dietary trial.Outcome: Time to additional breast cancer events.Results: The women who did not receive any systemic treatment had a higher risk for time to additional breast cancer events (HR=1.9, 95% CI: 1.32, 2.73) and for all-cause mortality (HR=1.7, 95% CI: 1.06, 2.73) compared to those who had received systemic treatment. Among 177 women who did not receive systemic treatment, CAM use was not significantly related to additional breast cancer events. There were no significant differences between high supplement users (≥3 formulations per day) and low supplement users in either risk for additional breast cancer events.Conclusion: The risk for an additional breast cancer event and/or death was higher for those who did not receive any systemic treatments; the use of dietary supplements or CAM therapies did not change this risk. This indicates that complementary and alternative therapies did not alter the outcome of breast cancer and should not be used in place of standard treatment.

Clinical evaluation of liquid placebos for an herbal supplement, STW5, in healthy volunteers - Corrected Proof

2012-04-30

Summary: Background: Although clinical trials are needed to evaluate the efficacy of liquid herbal medicinal products, design of feasible placebos that mimic the appearance, taste, and smell of such products is particularly challenging.Objective: The design and feasibility of a liquid placebo for STW5, an herbal medicinal product used for various gastrointestinal problems, was explored in this study.Design: Four sample products—STW5, a fresh and aged version of a placebo made from a seasoning mix (Maggi™), and a placebo with aged artificial flavor and food coloring—were compared in two organoleptic (sensory), single-blind trials with a total of 60 (N=60) healthy volunteers (n1=30, n2=30).Measurements: The appearance, smell, and taste of each solution were evaluated using a Likert scale questionnaire.Results: The liquid placebos evaluated were similar in regard to appearance, smell, and taste. However, participants indicated that for a clinical trial with STW5, the aged Maggi™ placebo would be more viable compared to the fresh Maggi placebo or the aged artificial food coloring placebo with licorice flavor. Participants also noted that the mint flavor and smell of STW5 was distinctly different from the placebo solutions.Limitations: The trials were conducted in healthy volunteers, not in actual patients.Conclusions: The aged Maggi™ liquid mix may be more favorable as a placebo than the artificially created one. However, further adjustment will need to be made to the Maggi™ placebo to simulate the complex aromatic composition of STW5 for clinical studies in the future.

Defining research priorities in complementary medicine in oncology - Corrected Proof

M. Robotin, C. Holliday, A. Bensoussan — 2012-04-25

Summary: Objectives: The high usage of complementary and alternative medicines (CAM) by cancer patients is increasing, despite limited research available to support their use. Therefore identifying research priorities that can inform the evidence base for CAM treatment is relevant for many stakeholders, including funders, researchers and consumers.Design and setting: Integrative medicine experts, oncologists with interest in CAM research, consumer representatives and CAM practitioners and researchers took part in a modified Delphi process conducted online over three rounds. In round 1 each participant recommended up to five CAM research priorities, which were collated and ranked in round 2 by their potential usefulness in cancer care, using a Likert scale. In round 3, participants ranked the remaining propositions by their ability to impact cancer care in Australia. The lowest ranking priorities were eliminated at the completion of each round.Results: From the 122 propositions originally submitted by the 27 participants, the highest scoring ones included: studying interactions between biologically based CAM and conventional cancer treatments, examining CAM effects on quality of life, identifying effective communication strategies around CAM, studying the role of physical activity in symptom relief and cancer prevention and exploring the role of acupuncture in cancer care.Conclusion: This method of research prioritisation achieved consensus of opinion among a very diverse group of stakeholders, invited to collaborate around a highly polarising topic. Through a structured interaction, the group agreed on a priority research list acceptable to all stakeholders, which can serve as a blueprint for CAM research in oncology in Australia.

Development of differential criteria on tongue coating thickness in tongue diagnosis - Corrected Proof

2012-04-23

Summary: Objective: To develop differential criteria on the tongue coating thickness (TCT), and especially propose the standard for judgment on thin and thick coating in tongue diagnosis.Methods: Sixty oriental medical doctors evaluated the TCT (none, thin, and thick coating) in 50 realistic tongue photographs revealing from tip-to-root. The photographs were obtained with a digital tongue imaging system (DTIS) which measured the percentages of tongue coating on the tongue surface. We calculated the match rate which is the ratio in which the assessor's judgment is consistent with the decision standard on the tongue coating, and then 24 assessors (≥80% match rate) were selected to improve the reliability of the decision. The agreement level among 24 assessors was examined to assess the inter-rater reliability. The correlation between TCT judgments and DTIS-measured values was examined to ascertain the reliability of DTIS measurements. Finally, the assumption probability for the analysis of quantified characteristics of the tongue coating was calculated with a proportional odds model.Results: The inter-rater reliability was assessed as moderate (κ=0.56) among 24 assessors, the level of correlation between TCT judgments and DTIS measurements in 24 assessors was relatively high (0.76, p<0.01). As the analysis of the proportional odds model, 29.06% was a cut-off point to separate no coating and thin coating, 63.51% was a cut-off point to separate thin and thick coating.Conclusions: The differential criteria for TCT in tongue diagnosis were suggested, and particularly thick coating is defined as one that tongue coating which tongue body is invisible, occupy approximately more than two third areas on the tongue surface.

Faith and use of complementary and alternative medicine among heart attack patients in a secular society - Corrected Proof

2012-04-02

Summary: Objectives: To explore the associations of religious and spiritual faith (unambiguous, ambiguous and no faith), existential considerations and disease severity with use of complementary and alternative medicine (CAM) among heart patients in a secular society, and to address patients’ perceived influence of CAM on their quality of life and heart disease.Design and setting: Prospective questionnaire study among 97 consecutively recruited patients (72.2% male; mean age 60.6 years) with acute coronary syndrome from a Danish cardiac university hospital unit.Main outcome measures: Total CAM use in the 6 months following hospitalisation.Results: Altogether 24.7% used CAM with dietary/exercise counselling and dietary/nutritional supplements being the most prevalent types. In a final multivariate logistic regression model entering faith in God, faith in a spiritual power and previous CAM use, only unambiguous faith in God predicted CAM use following the event (OR: 11.24, CI: 2.19–57.65, p=0.004). No significant association was found between heart disease severity and CAM use. The majority of CAM treatments were rated as having some degree of positive influence on quality of life (75.9%) and the heart disease (58.6%).Conclusions: Faith among heart patients in a secular society was associated with CAM use. It may be speculated that believers in God were more inclined to use lifestyle-oriented CAM types such as dietary/exercise counselling. Patients’ perceived benefits of CAM may be strong motivational factors for present or future use. However, considering the potential adverse effect of combining some complementary therapies with conventional medicine, an open dialogue on CAM use is warranted.

Attitudes and beliefs of paediatric oncologists regarding complementary and alternative therapies - Corrected Proof

2012-03-26

Summary: The last decades have seen increasing patient use of complementary and alternative treatment methods (CAM) in paediatric oncology, too. However, there have been few scientific studies of paediatric oncologists’ views and attitudes on CAM to date.We report the results of a cross-sectional questionnaire survey amongst paediatric oncologists in Germany. In addition to descriptive statistics, dichotomous subgroups were formed and univariate and multivariate analyses performed.There were 175 evaluable questionnaires (response rate 26.5%). Almost half of the responders (48%) had not been taught anything about CAM at medical school. Knowledge about CAM was found significantly more often in younger doctors (<43 years), in doctors who brought up the subject of CAM with the parents and in doctors working in non-university hospitals with fewer than 50 new admissions per year. A little over half of the responders (56%) had never used CAM when they had been ill themselves. Most of the doctors (78.9%) agreed fully or somewhat with the statement “CAM should be used after completion of the conventional treatment”. Older doctors agreed significantly more often that CAM should be used after failure of the conventional treatment. Paediatric oncologists were worried about CAM use by their patients because of possible interactions (76%) or side-effects (65.7%), additional costs (75.4%), possible prevention or delay of conventional treatment (68%) and their own lack of competence to provide advice. The topic of CAM was raised at the first consultation by 41.1% of the responders. A wish for more continuing medical education on CAM was expressed by 85.2%.In summary, the data presented here indicate that the majority of the responding German paediatric oncologists is open towards continuing medical education on CAM, not least in the interest of becoming more competent to advise their patients. This is in contrast to the fact that German paediatric oncologists currently tend not to actively bring up the topic of CAM in their consultations with parents. Younger doctors with shorter professional experience in paediatric oncology currently have a fundamentally more positive attitude towards CAM issues.

Eurythmy therapy in the aftercare of pediatric posterior fossa tumour survivors—A pilot study - Corrected Proof

2012-03-26

Summary: Background: Pediatric posterior fossa brain tumour survivors are burdened with extensive neurologic, emotional, behavioral and mental impairments. Even long-term common remediation therapies such as conventional physical therapy and occupational therapy do not warrant full recovery. Innovative complementary therapy strategies offer a new option that needs evaluation. EYT is a movement therapy that belongs to the field of mind-body therapies (MBTs). This holistic approach aims to promote self-regulation and self-healing powers e.g. in cancer patients. This pilot study is a first attempt to assess the feasibility, treatment adherence and impact of eurythmy therapy (EYT) in pediatric neurooncology.Methods: Seven posterior fossa tumour survivors who each participated in 25 EYT interventions over 6 months were followed for an additional 6 months. The outcome parameters cognitive functioning, neuromotor functioning and visuomotor integration were assessed at baseline as well as six and 12 months afterwards.Results: We found good adherence and improvements in cognitive and neuromotor functioning in all children and better visuomotor integration in 5/7 children after 6 months. After 12 months, neuromotor functioning and visuomotor integration diminished again to some extent.Conclusion: EYT in pediatric cerebellar tumour survivors is feasible and patients may profit from this new approach.

Keeping the balance – an overview of mind–body therapies in pediatric oncology - Corrected Proof

Jenny Lena Kanitz, Maria Eugenia Moneta Camus, Georg Seifert — 2012-03-23

Summary: This overview aims to give a brief introduction for clinicians in the wide field of Mind–Body Therapies (MBTs), to summarize the current research status of MBTs in pediatric oncology and to mention challenges for future goals. Most used techniques (relaxation, hypnosis, yoga, massage, MBSR, eurythmy) will be described and efficacy will be discussed. MBTs are an enhancement of conventional medicine to motivate the patient to participate in his recovery. Most MBTs are of low risk and are accessible for patients and their families in nearly all stadium of cancer therapy. Positive results include increased self-confidence and a more optimistic view in coping with the illness. We encourage clinicians to be more aware of the promising field of MBTs and its use in pediatric oncology.

Acupoint stimulation intervention for people with primary dysmenorrhea: Systematic review and meta-analysis of randomized trials - Corrected Proof

Yu-Chu Chung, Hsing-Hsia Chen, Mei-Ling Yeh — 2012-03-19

Summary: Background: Primary dysmenorrhea is a common gynecologic complain in women of reproductive age. Acupoint stimulation therapies might be an effective intervention for primary dysmenorrhea.Objective: The aim of this study was to determine the effectiveness of acupoint stimulation for primary dysmenorrhea.Data sources: All searches in the Cochrane Library, MEDLINE, PubMed, CINAHL Plus with Full Text, and CEPS databases (inception to March 2011).Study selection: Randomized controlled trials (RCTs) included were comparing acupoint stimulation with non-acupoint-related stimulation or medication.Data extraction: Data were abstracted independently by two authors onto standardized forms, and disagreements were resolved by discussion.Data synthesis: Thirty RCTs met the selection criteria, and 25 reported sufficient data for pooling. The main outcomes assessed were cure rate, total effective rate, pain intensity, menstrual pain, plasma PGF2α/PGE2 ratio, and adverse events. According to the type of outcome, the strength of a relationship between two dichotomous variables was described by odds ratios and 95% confidence intervals, and continuous variables were expressed as mean±standard deviation. Fixed-effects models were used to perform meta-analysis.Results: Twenty-five RCTs with a total of over 3000 participants were included for the meta-analysis. Acupoint stimulation when compared with non-acupoint-related stimulation or medication had significant effects. Moderator analysis further confirmed that invasive and noninvasive acupoint stimulation was effective separately, with the latter being more effective. The most common adverse events were hemorrhage and hematoma.Limitations: Papers written in language other than English or Chinese were not included.Conclusions and implication: This finding indicates that acupoint stimulation, especially non-invasive acupoint stimulation, could have good short term effects on pain of primary dysmenorrhea. Inference in some studies was somewhat restricted due to low methodological rigor. We suggest well-designed, methodologically rigorous, large trial, evaluating both short and long-term effects on pain and other outcomes in comparison with the available standard treatments.

Complementary and alternative medicine in paediatrics in daily practice—A European perspective - Corrected Proof

Alfred Längler, Tycho J. Zuzak — 2012-03-05

Summary: Introduction: Complementary and alternative medicine (CAM) is used by both adults and children in Europe. Diverse cultural, ethnic and historical preconditions in European countries result in broad differences between the types of CAM practiced, prevalence of CAM use and integration in the health system. To date, no survey of CAM availability to paediatric patients in Europe exists.Methods: We present an overview of CAM integration within the different levels of the European paediatric health systems as a narrative review. Paediatric CAM specialists in 20 European countries provided information about CAM integration in their countries in semi-structured interviews.Results: Data from 20 European countries were available, representing 68% of the European population. CAM is offered in private practices in all 20 (100%) countries, and 80% described some form of CAM training for health professionals. While CAM is offered in outpatient clinics treating adults in 80% of these countries, only 35% offer CAM in paediatric outpatient clinics. Dedicated CAM inpatient wards exist in 65% of the countries for adults, but only in Germany and the Netherlands for children. Groups conducting some CAM research or CAM research focussed on paediatrics exist in 65% and 50% of the 20 countries, respectively. Homeopathy, acupuncture and anthroposophic medicine were most often named.Conclusion: Every child in Europe has access to CAM treatment, mainly in private practices, whereas CAM outpatient clinics and inpatient services for children are rare. This is in contrast to adult treatment facilities, many of which offer CAM services, and the high percentage of European children using CAM.

Use of complementary and alternative medicine by children in Europe: Published data and expert perspectives - Corrected Proof

2012-02-06

Summary: Introduction: Few data document the use of complementary and alternative medicine (CAM) in Europe, with even fewer investigating use by children.Methods: A narrative, non-systematic review of CAM use in Europe was performed by combining data from published surveys with expert perspectives. Limitations created by a lack of representative studies, varying definitions of CAM use, and what qualifies as CAM in different countries was partially overcome by integrating local experts to summarise information available only in the national language and provide their perspectives about CAM availability, quality, use and popularity in their countries using a semi-structured questionnaire. Local and international published surveys were summarised, and the prevalence of CAM use was extrapolated.Results: Data from 20 European countries were available, representing 69% of the European population. Some data about CAM use by the general population were available for 90% of the examined countries, whereas peer-reviewed published surveys were available for only 60%. We extrapolated that 56% (range: 10–90%, adjusted for population size) of the European population in general had used CAM at least once in the past year. Surveys in CAM use by children were available for 55% of the investigated countries. The extrapolated prevalence of CAM use by children in Europe was 52% (range: 5–90%, adjusted for population size). Paediatric CAM experts reported an increasing awareness for and use of CAM in healthcare institutions.Conclusion: This precursor for further surveys indicates that CAM appears to be popular not only among adults in Europe, but also for children. Development of a pan-European definition of CAM use and CAM therapies are required to achieve surveys comparable between European countries. Additionally, more research investigating the efficacy and potential adverse effects of CAM therapies is needed because of increasing CAM use by children in Europe.

Surveys of complementary and alternative medicine usage: A scoping study of the paediatric literature - Corrected Proof

Soleil Surette, Leah Vanderjagt, Sunita Vohra — 2011-09-23

Summary: Objective: To conduct a scoping review of paediatric CAM utilisation literature, in order to establish the depth and breadth of the field and identify gaps in knowledge regarding the epidemiology of CAM use.Methods: A CAM and paediatric search strategy was developed and run in three databases (Medline, Embase, Amed) in June 2006. It was revised and rerun in February 2010. Utilisation studies about paediatric CAM were selected if they had an English or French abstract. Data were extracted into an excel table by one individual.Results: 152 paediatric CAM utilisation studies were identified as of February 2010, 136 were fulltext English. There was variation in how CAM was defined: vitamins were included in 35 studies, excluded in 12 studies and not mentioned in 40; while prayer was included in 64, excluded in 9, and not mentioned in 39. Over half of the studies identified were from North America. The majority of studies were conducted in conventional health settings. The four most commonly studied subpopulations were cancer, asthma, autistic spectrum disorder, and attention deficit hyperactivity disorder. Eighteen percent of studies did not report on the period of assessment used. Twenty-seven percent of studies inquired about adverse events and 32% inquired about costs and insurance coverage.Conclusion: There are substantial paediatric utilisation data available but some subpopulations remain poorly researched. The need for transparent utilisation data remains important in order to help prioritize safety and efficacy research.

Perspective on fever: The basic science and conventional medicine - Corrected Proof

Joseph G. Cannon — 2011-09-19

Summary: This review describes how fever is generated as a regulated increase in body temperature. It results from an upward shift in the thermoregulatory set point, mediated by pyrogenic cytokines released from monocytes/macrophages in response to infection or trauma. Evidence will be presented that fever is part of an integrated host defense system, and that failure to generate a fever in response to infection is generally associated with a poorer prognosis.

Use of complementary and alternative medicine in healthy children and children with chronic medical conditions in Germany - Corrected Proof

2011-07-11

Summary: Objectives: Use of complementary and alternative medicine (CAM) in children is common and probably increasing. However little is known about differences between healthy and chronically ill children with a focus on prevalence, reasons for use/non-use, costs, adverse effects and socio-demographic factors.Design: A questionnaire-based survey with 500 participants visiting the outpatient clinic of the University Children's Hospital Homburg, Germany was conducted over a 4-week period in 2004. Recruitment was stopped when 500 questionnaires were handed out in total.Results: Of the 405 (81%) respondents (242 with chronic conditions, 163 healthy children incidentally visiting the hospital for minor ailments) 229 (57%) reported lifetime CAM use (59% with chronic conditions versus 53% healthy children). Among CAM users the most prevalent therapies were homeopathy (25%), herbal remedies (8%), anthroposophic medicine (7%), vitamin preparations (6%) and acupuncture (5%). The main reasons for use were to strengthen the immune system, physical stabilisation and to increase healing chances/maintain health. Socio-demographic factors associated with CAM use were tertiary education (mother: p=0.017; father: p>0.001), higher family income (p=0.001) and being Protestant (p=0.01). Expectations towards CAM were high and most parents would recommend certain CAM (94%). 79% of the users informed a physician about CAM use. Side effects were rarely reported (4%), minor and self-limiting.Conclusions: Clinical care and the physician-patient relation would benefit from an enhanced understanding of CAM and a greater candidness towards the parental needs. The safety and efficacy especially of CAM with high prevalence rates should be determined in rigorous basic and clinical researches.

The PedCAM Network: Past, present, and future - Corrected Proof

Soleil Surette, Sunita Vohra — 2011-04-21

Summary: Established in 2004, the Pediatric Complementary and Alternative Medicine Research & Education (PedCAM) Network (www.pedcam.ca) is a multidisciplinary national and international network focused on pediatric research and education with the vision of safe and effective use of complementary and alternative medicine (CAM) use in children and youth and is designed to be a networking and information resource for both researchers and practitioners in the field of pediatric CAM. PedCAM offers a wide variety of resources and opportunities to researchers, clinicians, educators and the general public: educational, and funding opportunities; links to core articles and books; a searchable database of pediatric CAM research articles; biweekly electronic updates for members. Currently, it is engaged in several research projects to strengthen the pediatric CAM knowledge base: (i) a modified Delphi consensus process for establishing a pediatric CAM research agenda; (ii) the identification of validated pediatric outcome measures; and (iii) a synthesis of pediatric CAM utilization studies to identify knowledge gaps. The widespread use of CAM in children, and the resulting need for high quality research and education, suggests that the PedCAM Network will remain relevant and timely in its efforts to connect those working in the field of pediatric CAM in Canada and around the world.